AACN - Government Affairs

Testimony of Carole Anderson, PhD, RN, FAAN
On behalf of the American Association of Colleges of Nursing

On Fiscal Year 2002 Appropriations for Nursing Research and Education

March 20, 2001
Before the House Appropriations Subcommittee
on Labor, Health and Human Services, Education and Related Agencies

Good morning, Mr. Chairman and members of the Subcommittee. I am Carole Anderson, PhD, RN, FAAN, Dean of the College of Nursing at The Ohio State University in Columbus, Ohio. On behalf of the American Association of Colleges of Nursing (AACN), I appreciate this opportunity to bring to the Subcommittee our requested funding priorities for nursing research and education programs. This federal support will be a critical piece in the nation's effort to overcome the nursing shortage. AACN represents over 550 baccalaureate and graduate nursing education programs in senior colleges and universities across the United States.

The country is in the midst of an emerging nursing shortage unlike any that the nation has experienced over the past 30 years. Since 1994, AACN has noted declining enrollments in baccalaureate nursing programs. Increasingly, employers are reporting dramatic and crisis level shortages of nurses in their health care settings. Hospitals are forced to close entire patient care units; ambulances are being diverted to other overcrowded facilities; and surgeries are being canceled due to the lack of appropriately educated and skilled registered nurses (RNs). Nurse vacancy rates are noted in all practice settings including long-term care, home care, and public health. In addition, an aging workforce, with the average age of RNs up to 45.2 years, compounds the shortage.

Although employers are seeking a more highly educated nursing workforce for today's complex health care environment, only 41% of nurses have a baccalaureate or higher degree. The growing shortage and the decline in enrollments are accompanied by a number of other factors that will affect the ability of the nursing profession to meet the demand for professional nursing care. The longitudinal American Freshman Study indicates that an extremely small percentage of freshman college students are choosing a nursing career. A recent national assessment of children's career aspirations by the J. W. Thompson Company has found that young children, particularly those who plan to seek a college education, also do not see nursing as an attractive career option.

A lack of nursing faculty has had an impact on the shortage. The majority of AACN member nursing programs report great difficulty filling budgeted faculty positions. The small one percent of doctorally prepared nurses in this country and the lengthy completion time of a doctoral degree have limited the availability of nurses prepared to function in a faculty role. Doctoral nursing students also are more often part-time students and have maintained their full-time clinical or other positions. Expansion of doctoral enrollments as full-time students would facilitate greatly the production of available faculty. AACN members also report difficulty recruiting master's prepared nursing personnel for faculty roles because of the great disparity between clinical salaries and the salaries available as a faculty member. Schools would benefit from support initiatives that provide resources to augment salaries for specialized faculty needed to support the entire program.

AACN recognizes that strategies to meet the growing nursing shortage must encompass private and public sector initiatives. Local communities and health care employers are utilizing creative programs to recruit middle school students into the nursing profession. States are introducing legislation funding scholarships and studies to assess statewide workforce need. We are asking the Subcommittee to graciously consider these requests and the effect that an unresolved RN shortage of this magnitude will have on the future of health care in America.

Mr. Chairman, we thank you and respectfully request a Fiscal Year 2002 funding level of $144.37 million, which reflects an increase of $40 million for the National Institute of Nursing Research. At this funding level, NINR will support significant new research on health disparities in diseases such as diabetes and cardiovascular disease, self management of chronic pain, end-of-life research to address weight loss, muscle wasting, fatigue, and caregiver issues. Most critical to enhancing research within the nursing profession is infrastructure development that increases the pool of nurse investigators, expands programs to develop partnerships between research-intensive environments and smaller colleges and universities, and promotes career development for minority researchers.

In an effort to develop the pool of nurse faculty and researchers, NINR directs 8% of its budget to research training. Research training dollars supported approximately 190 pre-doctoral nurse researchers and 70 post-doctoral researchers this year. These numbers must be increased in the future to address recent recommendations of the National Research Council. Additionally, AACN's 2000 Survey of Institutional Data Systems claims 3,338 nurses in doctoral programs, indicating that NINR supports less than 6% of those nurses in doctoral study. In view of the national nurse faculty shortage of 500 unfilled positions in teaching and research, we recommend this significant increase in appropriations for additional stipends and training for pre- and post-doctoral researchers.

NINR provides research findings for the nation's largest profession of health care providers; 2.7 million RNs. In light of the increasing shortage of qualified professional nurses, the NINR requires a significant funding increase for the following reasons:

To provide clinically-based research findings that make a difference in the lives of all Americans, from our youth whose health needs must be addressed to our nation's aging population of which many experience chronic, debilitating diseases.
To establish the role of nurse researcher, which attracts bright young women and men into a field that provides opportunities to both conduct meaningful research and use important research findings that make a difference in people's lives.

We are grateful to the Subcommittee for supporting NINR with FY 2001 funding of $104.37 million. This is $14.83 million or 16.6% more than the FY 2000 level. Nurses from across the nation are thankful for this increase. It has provided resources for 81 new multi-year research grants beginning in FY 2000 and an estimated 60 new studies, which begin in FY 2001.

The increase in appropriation for FY 2000 enabled NINR's success rate to reach the NIH mean success rate of 32% for competing research projects for the first time in its 15-year history. This is a significant improvement over FY 1999 when the success rate was only 14.4%. Because of NINR's ability to attract important applications for research studies, the success rate for FY2001, despite a good increase in appropriation, is estimated to be only 20%.

The FY 2000 research findings from NINR-funded studies include 17 reports related to aging, long-term care, or Alzheimer's and care giving. More studies are reported in dozens of scientific articles in: HIV/AIDS patient care, cardiovascular disease prevention and care, child and adolescent health, critical care, diabetes, mental health, and the utilization of nurses in the health care system. In addition, NINR-funded investigators across the country produced scientific advances in maternal-infant care, pain and other symptom management, and women's health. These findings together form the research base to establish evidence-based practice for registered nurses providing direct patient care 24-hours a day, seven days a week, all across the country.

In addition, NINR is the lead institute at NIH to coordinate research on end-of-life care, addressing the public's disappointment with the current status of care at the end of life. Other groups such as the Institute of Medicine, the Robert Wood Johnson Foundation, and the Hartford Foundation recognizing this need especially in light of our aging population. End-of-life care utilizes many of the skills of nurses such as pain and other symptom management, clinical management to promote quality of life, and family teaching and counseling. This focus helps families to identify and use resources to better cope with the stresses at this critical time.

The Subcommittee investment in NINR is well justified as nursing research contributes extensively to wellness and health choices that prevent disease. The NINR supports investigators who conduct a broad range of clinical research, developing and testing interventions to improve patient care, treat disease, manage chronic conditions and address the physical and emotional concerns that are important to the diverse American public. There is growing evidence of advances made possible by NINR research, but I will highlight just four recent success stories. AACN believes that based on these and numerous other examples, it is clear that nursing research is making a difference in health outcomes. For example, NINR research has made a difference by identifying interventions or other studies to:

Enhance the independence and reduce signs of distress among severely cognitively impaired nursing home residents.
Develop new methodologies for investigating ways to reduce breast cancer risk in women who have a genetic predisposition.
Reduce the extremely high stress levels experienced by family members who were involved with decisions to stop life-sustaining support for a terminally ill loved.
Reduce the risk of cardiovascular disease in children from minority backgrounds who are living in rural areas.

Mr. Chairman, we are also here today to ask for increased funding for the Nurse Education Act and additional funding for the nursing student loan programs. AACN recommends an increase in the NEA for FY 2002 to $113.1 million with $10 million directed to student loan programs. NEA appropriations for FY01 were $78.1 million. Central to increasing the availability of a well-trained nursing workforce is the availability of educational grants and scholarships. Current demand for nursing student loan support exceeds significantly the resources available. In addition, scholarship support is a major incentive to enter the profession and facilitates full-time study.

Title VIII of the Public Health Service Act (PHSA), the NEA, is the major federal statute providing authority for the Department of Health and Human Services to fund initiatives to expand or improve nursing education. Authorities under Title VIII provide for support of advanced practice nursing education, special initiatives for nursing clinics, support of innovations in the delivery of nursing care, expansion of enrollments in baccalaureate nursing programs, and development of initiatives to expand minority nursing enrollments. Several of the programs assist schools with their efforts to bring more students into baccalaureate nursing programs. In addition, the program for loans to nursing students allows students to acquire low interest rate loans that can be repaid through service in high need areas.

Advanced Education Nursing Grants (Sec.811) - The initiative provides grants to schools to train advanced practice primary care nurse practitioners and nurse midwives. It also provides grants to educate master's and doctoral students as clinical nurse specialists, public health nurses, nurse administrators, faculty, nurse anesthetists, and non-primary care nurse practitioners. It includes traineeships for master's and doctoral students with a limit of 10% of appropriations for doctoral traineeships.
Nursing Workforce Diversity Grants (Sec.821) - To increase opportunities for nursing education for disadvantaged students, including underrepresented minorities, this initiative furnishes scholarships, stipends, pre-entry preparation, and retention activities. Grantees are responsible for accomplishing the objectives of their grants.
Basic Nurse Education and Practice Grants (Sec.831) - This initiative disseminates grants to schools of nursing to strengthen basic nurse education and practice with seven priority areas. The areas are: expanding nursing practice in non-institutional settings to increase access to primary health care, training for care of underserved and high risk populations, education for managed care, developing cultural competency, expanding baccalaureate enrollments, increasing nursing career mobility, and nursing education in informatics and use of distance learning.

AACN recommends an appropriation of at least $10.3 million for the NSLP for FY 2002. Administered by the Division of Student Assistance, this program was created to address nursing workforce shortages. Academic institutions select students enrolled in nursing programs for participation in the program based on financial need. The program operates on revolving funds received through student loan paybacks and returned funding received from nursing schools that closedown. Currently, only 200 of 1,500 eligible nursing schools participate in the program because of reluctance to compete for the limited funding.

AACN requests an additional $2 million for this program in FY 2002. The NELRP, administered by the Bureau of Primary Health Care, provides loans to registered nurses, nurse anesthetists, and nurse practitioners in exchange for practicing in designated Health Profession Shortage Areas. Due to funding limitations in FY 2000, the Bureau provided loans of 60% of the amount authorized to only 50% of the nurses applying for program participation.

AACN recommends that SDS be funded at $55.63 million for FY02, a 25% increase. FY 2001 funding is at $44.5 million. Scholarships for Disadvantaged Students is a PHSA Title VII program (Sec .737) that provides funds to disadvantaged and minority health professions students. The statute directs 16% of the funds appropriated to nursing students. This program is the major federal scholarship source for undergraduate nursing students and eliminates or reduces the financial barriers that may prevent these students from enrolling. The majority of SDS recipients are minority students.

AACN recommends maintaining the 10% set aside and increasing funds for the NHSC to $300 million. The National Health Service Corps Scholarship and Loan Repayment programs (PHSA Title III) seek to attract health professionals to practice in Health Professional Shortage Areas that lack such providers. Many of those areas are rural, and have difficulty attracting and retaining caregivers. Nursing has a 10% set aside that provides funding for certified nurse midwives, nurse practitioners, and psychiatric clinical nurses specialists.

In summary, AACN respectfully recommends the following appropriations for FY2002:

Thank you for your attention. I would be happy to answer any questions you might have.